Provider Demographics
NPI:1932126646
Name:AMD PROTECH
Entity Type:Organization
Organization Name:AMD PROTECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-583-0894
Mailing Address - Street 1:6760 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5827
Mailing Address - Country:US
Mailing Address - Phone:619-583-0894
Mailing Address - Fax:619-583-3174
Practice Address - Street 1:6760 UNIVERSITY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5827
Practice Address - Country:US
Practice Address - Phone:619-583-0894
Practice Address - Fax:619-583-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5879110001Medicare NSC